Provider Demographics
NPI:1013292184
Name:HEBL, GREG WILLIAM
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:WILLIAM
Last Name:HEBL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 VERONA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2736
Mailing Address - Country:US
Mailing Address - Phone:608-271-7822
Mailing Address - Fax:608-271-3657
Practice Address - Street 1:4641 VERONA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2736
Practice Address - Country:US
Practice Address - Phone:608-271-7822
Practice Address - Fax:608-271-3657
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10743-010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33023100Medicaid